Lorenzetti F, Kuokkanen H, von Smitten K, Asko-Seljavaara S
Department of Plastic Surgery, Helsinki University Hospital, Finland.
Ann Plast Surg. 2001 Jun;46(6):590-3. doi: 10.1097/00000637-200106000-00003.
Although the free microvascular transverse rectus abdominis musculocutaneous (TRAM) flap is in routine use for breast reconstruction, little is known of its hemodynamics. The purpose of this study was to determine whether any differences exist when the free TRAM flap is anastomosed to the thoracodorsal or internal mammary vessels. The study comprised 25 patients receiving a free TRAM flap for breast reconstruction. The thoracodorsal vessels were used as recipients in 21 patients and the internal mammary vessels were used in 4 patients. Blood flow rate was measured directly in the donor and recipient arteries, and after anastomosis by a transit-time ultrasonic flowmeter (CardioMed). Two- and 3-mm probes were used. The blood flow rate in the donor artery (deep inferior epigastric) before flap dissection was 11 +/- 6 ml per minute (mean +/- standard deviation). The rate was significantly (p < 0.05) lower (5 +/- 3 ml per minute) in the recipient thoracodorsal artery than in the donor, but after transplantation it increased to 14 +/- 5 ml per minute (p < 0.05), attaining the same value as the donor artery. The blood flow rate in the intact internal mammary artery was significantly higher (25 +/- 10 ml per minute) than in the donor and thoracodorsal arteries, but after anastomosis it dropped to the same value (12 +/- 3 ml per minute; p < 0.05) as the donor artery. The intake of blood in TRAM flaps supplied by the intemal mammary artery seems to be no greater than that in free flaps anastomosed to thoracodorsal vessels, although the flow in the internal mammary artery was much higher. The authors concluded that the blood supply in a free TRAM flap is independent of the flow in the recipient artery and that thoracodorsal vessels, although often in a scarred bed and radiated, are as suitable for anastomosing a free TRAM flap as are internal mammary vessels.
尽管游离微血管横腹直肌肌皮瓣（TRAM瓣）在乳房重建中已常规使用，但其血流动力学情况却鲜为人知。本研究的目的是确定游离TRAM瓣与胸背血管或胸廓内血管吻合时是否存在差异。该研究包括25例行游离TRAM瓣乳房重建的患者。21例患者采用胸背血管作为受区血管，4例患者采用胸廓内血管。使用通过时间超声流量计（CardioMed）直接测量供体和受体动脉以及吻合后的血流速度。使用2毫米和3毫米的探头。皮瓣切取前供体动脉（腹壁下深动脉）的血流速度为每分钟11±6毫升（平均值±标准差）。受体胸背动脉的血流速度（每分钟5±3毫升）明显低于供体动脉（p<0.05），但移植后增加到每分钟14±5毫升（p<0.05），达到与供体动脉相同的值。完整胸廓内动脉的血流速度明显高于供体和胸背动脉（每分钟25±10毫升），但吻合后降至与供体动脉相同的值（每分钟12±3毫升；p<0.05）。尽管胸廓内动脉的血流要高得多，但由胸廓内动脉供血的TRAM瓣的血液摄取似乎并不比与胸背血管吻合的游离皮瓣多。作者得出结论，游离TRAM瓣的血液供应与受体动脉的血流无关，并且胸背血管尽管常常处于瘢痕化和受过放疗的区域，但与胸廓内血管一样适合于吻合游离TRAM瓣。
